UAB - The Challenges Lived and The Lessons Learned ......[MoH], 2011) Cambodian health remains the...
Transcript of UAB - The Challenges Lived and The Lessons Learned ......[MoH], 2011) Cambodian health remains the...
The Challenges Lived and
The Lessons Learned
Teaching Nursing in
Cambodia
Dr. Karen Reed, RN
Clinical Assistant Professor
University of Florida
College of Nursing
Once upon a dare……
Cambodia is a poor
country in Southeast
Asia with 80% of 14.4
million people
surviving as
sustenance farmers. (Cambodian Ministry of Health
[MoH], 2011)
Cambodian health
remains the lowest in the
Western Pacific Region
and ranks 174th out of
190 countries. (World Health Organization [WHO], 2010).
Only 12% of
Cambodian
homes have
electricity. (US Ambassador Todd,
Interview, 2012)
Population: 14.9 million
Average Age: 23.3 years
Infant Mortality:
55 deaths/ 1,000 births
Maternal Mortality:
250/ 100,000
Life Expectancy: 62 years (Central Intelligence Agency [CIA], 2012)
Countries in
SE Asia
Number
Physicians
Number
Nurses
Cambodia .16/ 1,000 .61/ 1,000
Vietnam 1.22/1,000 1.01/ 1,000
Laos .27/1,000 .97/1,000
Source: World Bank, 2010
Killing Cave used by Khmer Rouge, Kampot
Non-communicable Disease Burden:
Urban Areas:
10% of adults have
diabetes
25% high blood
pressure
Rural Areas:
5% of adults have
diabetes
12% hypertension
Cigarette Use:
48% of men
3.6% of women
Chewed Tobacco Use:
17% of women
1% of men
Land mines and road accidents are the most significant causes of traumatic injury and death in peacetime Cambodia.
Land mines are particularly serious for children and youth who attempt to salvage unexploded ordinance to sell it as scrap metal (UNICEF, 2009).
Traffic Fatalities
Second Leading Cause of Death
1979:
20 physicians (45)
26 pharmacists
28 dentists
728 medical
students
20 nurses
The Health System:
Starting Over
Level 1: Operational Districts Serving
100,000 - 200,000 pop
Referral Hospital & Network of Health Centers
Level 2: Provincial Hospital & Provincial Health
Department
Level 3: Ministry of Health, National Institutes,
National Hospitals, National Programs, & Training
Institutions
8 National Hospitals
73 Operational Districts
67 Referral Hospitals
823 Health Centers
The Health System: 1995- Present
There are 5 public nursing
programs in Cambodia:
•Technical School for
Medical Care
•Kampot RTC
•Stung Treng RTC
•Battambang RTC
•Kampong Cham RTC
RTC= Regional Training Center
Dormitory in Kampot
TSMC, Phnom Penh
Kampot RTC
Cambodian Nursing Education System
Bachelor’s Degree – 4 years
(only TSMC)
Secondary Nurse- 3 years
Primary Nurse- 1 year
Secondary Nurse Midwife- 3 years
Primary Midwife- 1 year
Secondary Nurse/ Midwife- 3 + 1 (not
Stung Treng RTC)
Secondary Nurse/Dental Nurse- 3 years
(only Kampong Cham RTC)
Cambodian
Nursing Classroom Resources (Sources: Direct Observation, Cambodian Interviews, & JICA)
Out- dated libraries in 4 of 5 nursing
programs. Stung Treng has no library.
3 of 5 programs have equipment in
poor condition. TSMC and Kampot
RTC have best maintained equipment.
Faculty are not permitted to use
equipment in some programs and/ or
faculty lack knowledge of use.
Cambodian
Nursing Classroom Resources (Sources: Direct Observation, Cambodian Interviews, & JICA)
Nursing lab (demonstration room) in 4 of 5 nursing programs; however, Battambang RTC has their nursing lab on the roof. Stung Treng has no nursing lab.
Typical classroom size: 90-122 students in room
Typical classroom: long and narrow; overcrowded
Challenges:
The Ministry of Health oversees the funding, staffing, and content of the five regional training centers that provide a
three year nursing program.
No nationally specified terminal program outcomes.
There is program inconsistency on the subject matter taught.
Faculty lack baccalaureate or advanced nursing degrees and academic preparation in education principles associated with course construction, teaching methodologies, and evaluation.
Cultural Considerations
"Culturally congruent" education is
education that is "provided in a manner
that is meaningful and useful“. (Cr ane, 2006).
Nursing education must be presented
with the local cultural, religious,
economic, social environmental and
political influences in mind (Mur r ay, 2005).
Challenge:
Rules of Propriety and Attitudes
About Time
Do I move my hands,
arms, body location?
Use of touch?
Meeting/ Greeting
Gaining Attention
Giving Praise
Emphasizing
Giving Correction
Challenge:
Adapting Our Teaching Techniques
Abroad Which Work Well in the US
Teaching Methods
Work sheets and color pencils
Teams were used to develop nursing care plans/answer case study questions
Games, such as Jeopardy, to encourage learning and promote active interaction.
Donors provided pen lights, ink pens, clips, tote bags and candy for prizes and gifts.
Same- Same,
but Different!
Use of Stories
Preparing Outlines
Be Clear and Culturally Alert
Make Lecture Information Personal
Invite Listener Questions
Use Illustrative Examples
Simplify the Vocabulary
Repeat & Summarize Carefully
Repeat and Repeat Again
Break up Lecture w/ Demonstrations & Breaks
Challenges for Cambodian
Nursing Education
Lecture plans are not based on evidence, are not scientific, and are poor in quality.
Faculty lack appropriate teaching knowledge and skills.
Faculty do not supervise students in clinical setting
No mentoring of nurses in provincial hospitals on how to supervise nursing students
Nurse: Student Ratio in clinicals 1:20-35
No incentive for nurses to supervise nursing students.
English Language &
Cambodian Nursing Faculty (Sources: Cambodian Interviews- 2012 & Japan International Cooperative Agency- 2011)
Nursing Programs were asked to
self-report English speaking skills of
faculty to JICA.
3.4% Very Good (N=3)
89.7% Good (N=78)
Direct experiences at all 5 nursing
programs found a very different
situation. (11/1/6)
Challenges for Cambodian
Nursing Education (Sources: Direct Observation, Cambodian Interviews, & JICA)
No textbooks in Khmer (major language) Textbooks are not available to students English language lessons are not
available to students in 4 of the 5 nursing programs.
Nursing programs are not internationally recognized due to limited quality and content.
WHO has a collaborative program with the University of the Philippines to create a “bridge program”. Piloted in TSMC.
Challenge:
Cultural Hurdles
Political Hurdles
Structural Hurdles
Child Trafficking
Lack of Resources -
Environment
Lack of Clean Water
Lack of Safe Food
Environmental Concerns Beyond Capacity
(arsenic in ground water)
Future Directions
There is a need for Cambodian nurses to
learn the leadership skills necessary to
foster the role of professional nursing in
Cambodia’s
health care
system.
Future Directions There is a need to expand the current
nursing education options to include
BSN and graduate programs, with
access to such programs either in- country
or via distance programs.
Future Directions There is a tremendous need for masters
prepared nurses to assist Cambodian
nursing faculty in developing their
educational delivery skill set and knowledge
base.
Future Directions
There is an opportunity for nursing programs
in developing nations to work together to foster
nursing education/ health care in Cambodia.
Questions?